Part B Insider (Multispecialty) Coding Alert

If you do append modifier 22 in obesity cases, you should double and triple check your documentation to warrant the extra pay.

Question: Our physician performed open treatment of a bimalleolar fracture on an obese patient. Is it acceptable for us to append modifier 22 to the procedure code to indicate the extra work performed due to the patient's obesity?

Answer: The fact that the patient is obese is not necessarily enough reason to append modifier 22 (Increased procedural services) to a procedure code (such as 27814, Open treatment of bimalleolar ankle fracture [e.g., lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli], includes internal fixation, when performed).

If, however, the surgeon documents how the patient's obesity increased the complexity of that particular case, you may have support for appending the modifier.

Best bet: In a separate paragraph, the surgeon should give the specifics of how much more time, skill, or work (such as finding appropriate positioning for the patient) the procedure required because of the patient's obesity.

Tip: Put the support for modifier 22 at the beginning of the op note so the claims reviewer can't miss it. You also should include documentation of the extra time and work in the letter you send supporting the claim.

The surgeon also should document the patient's body mass index (BMI). You should indicate the BMI on the claim using the appropriate code from the 278.0X (Overweight and obesity) range and the matching V code (V85.0-V85.54, Body Mass Index).

In addition to the obesity code, you should report the appropriate fracture code (such as 824.4, Fracture of ankle; bimalleolar, closed). Remember to sequence the fracture diagnosis first.

Keep in mind: Insurers consider payment for modifier 22 on a case-by-case basis, after reviewing the operative report, so you can't assume modifier 22 will be consistent between procedures.